Tooth Wear 3 Flashcards
(32 cards)
In regard to anterior wear, what factors from the teeth are likely to give a high degree of confidence if they are restored?
- If destruction is relatively minimal and limited to the palatal surfaces
What are the contra indications for restoring teeth with anterior wear?
- Short roots
- Reduced periodontal support due to periodontal disease
What reduces the success rate of restoring teeth with anterior wear?
- Lack of remaining enamel
What is the ‘Ring of confidence’ of remaining enamel?
- Insert picture
- Very positive influence on retention
Why is lower anterior tooth wear more difficult to fix than maxillary wear?
- Less enamel so smaller bonding area
When considering restoring lower anterior tooth wear what are the main points to consider?
- If poss then improve aesthetics but do not increase OVD
- If you need to build them up do this before uppers
- Use same technique as upper
What pts are you most commonly going to see localised posterior tooth wear?
- Erosive toothwear in ruminating pts
- Erosive in bulimic and alcoholic pts
- Unusual on its own (combined with anterior tooth wear)
What is the most appropriate txt for localised posterior tooth wear if asymptomatic?
- Prevention and monitoring
How can occlusal erosive wear be treated?
- Filled directly with composite with no change to occlusion
Why does localised posterior tooth wear occur most likely?
- Often there is canine wear
- This has removed guidance and led to posterior wear
What is the restorative txt for localised posterior tooth wear?
- Provide sufficient canine guidance to ensure posterior disclusion
- Composite resin added to palatal of upper canine to increase canine rise and disclude posteriors during lateral and protrusive excursions
- Can be done freehand or with use of diagnostic wax and template
What are some of the methods for composite build up?
- Alginate impressions
- Diagnostic Wax up
- Putty matrix
- Clear vacuum formed matrix
What are the advantages of using composite resin restorations for anterior tooth wear?
- Good pt satisfaction
- Posterior occlusion normally re-achieved
- Seldom TMJ problems
- No detrimental effect on pulpal health
- No worsening of periodontal condition
What info do you give to the pt before they receive comp resin restorations for toothwear?
- Your front teeth will receive tooth coloured fillings to cover exposed and worn tooth surfaces
- This will help prevent them wearing more
- This is the main reason for your txt
- This procedure will be carried out without LA as there will be no or minimal drilling of your teeth
- We add to your teeth not remove any
- Improvement in the appearance should be poss
- Your bite will feel strange for a few days and you may have difficulty chewing (- only your front teeth will touch together - Your back teeth will gradually come back together but this will take 3-6 months)
- In about a week or so you will become accustomed to your new bite and will be able to ear more but initially cut food into smaller pieces to help with swallowing and digestion
- Change in shape of front teeth may cause lisping for few days
- Front teeth may feel a little tender to bite on for few days
- You may bite lips and tongue at first
- If you have crowns/bridges or partial dentures at the back of your mouth it is likely that these will need to be replaced
What info do you tell the pts regarding longevity of comp resin restorations for anterior wear?
- Longevity is good but there is small potential for restorations to debond and fall off but can be replaced with no damage to your remaining tooth
- These restorations will require maintenance as margins will require occasional polishing and chipping may occur so need to be fixed
How does generalised tooth wear occur?
- Most (but not all) begin as localised anterior tooth wear and it is not treated
- Rare but is increasing in incidence
What are the 3 categories that generalised tooth wear can be put into?
- Excessive wear with loss of OVD
- Excessive wear without loss of OVD but with available space
- Excessive wear without loss of OVD and with no space available
What is the best txt approach to generalised tooth wear?
- If poss an adhesive approach should be used
- Can be used to assess pts tolerance of new occlusal scheme as medium term restorations
What are txt options for Generalised tooth wear - Excessive tooth wear with loss of OVD?
- Easiest to txt but also least common
- Splint to assess pt tolerance of new face height
- Or go straight to increase face height with permanent bonded restorations
- Mixture of adhesive and conventional restorations required
- Can use dentures to provide posterior support at new OVD
- Ideally half OVD increase should be maxillary and other half mandibular
What are the txt options for generalised tooth wear - Excessive tooth wear without loss of OVD But with Limited Space available?
- More complicated to treat
- Can involve re-organisation of occlusion
- Splint should be considered as increase in occlusal face height required
- Restoration of anterior and posterior teeth is then carried out at new occlusal face height
- If poss should involve min prep adhesive restorations
What are the txt for generalised tooth wear - Excessive tooth wear without loss of OVD with no Space available?
- Most severe difficult to txt
- Specialist opinion prior to commencing txt
- Attempt to increase OVD by use of splints+/- dentures if there is lack of posterior support
- Crown lengthening surgery
- Elective endodontics ( destructive posts and cores and attrition don’t go together
- Orthodontics
What is Crown lengthening used for?
- To increase amount of coronal tooth substance available
Disadvantages of crown lengthening?
- May result in black triangles between teeth where ID papilla further down
- Can lead to unfavourable crown to root ratio
- Increased chance of loosening or tooth movement if tooth loaded subsequently
- Post op sensiitvity
- Any subsequent conventional crown prep will be further down root so increase chnace of pulpal damage and it is a problem if tooth has sig coronal-cervical taper
When can overdentures be considered as txt option?
- For pts with Excessive tooth wear without loss of OVD with no Space available
